Introduction

Functional status (FS) and frailty are significant concerns for older adults, especially those with cancer. Data on FS (Activities of Daily Living [ADL]; Instrumental Activities of Daily Living [IADL]) and its evolution during cancer treatment in older patients and a frailty risk profile are scarce. Therefore, this study examines FS and its evolution in older patients with cancer and a frailty risk profile and investigates characteristics associated with functional decline.

Material and Methods

This secondary data-analysis, focusing on FS, uses data from a large prospective multicenter observational cohort study. Patients ≥70 years with a solid tumor and a frailty risk profile based on the G8 screening tool (score ≤ 14) were included. A geriatric assessment was performed including evaluation of FS based on ADL and IADL. At approximately three months of follow-up, FS was reassessed. Univariable and multivariable logistic regression analyses were used to identify predictive factors for functional decline in ADL and IADL.

Results

Data on ADL and IADL were available at baseline and follow-up in 3388 patients. At baseline 1886 (55.7%) patients were dependent for ADL, whereas 2085 (61.5%) patients were dependent at follow-up. Functional decline was observed in 23.6% of patients. For IADL 2218 (65.5%) patients were dependent for IADL, whereas 2591 (76.5%) patients were dependent at follow-up. Functional decline in IADL was observed in 41.0% of patients. In multivariable analysis, disease stage III or IV, comorbidities, falls history in the past twelve months, and FS measured by IADL were predictive factors for functional decline in both ADL and IADL. Other predictive factors for functional decline in ADL were polypharmacy, Eastern Cooperative Oncology Group-Performance Status (ECOG-PS) score 2–4, and cognitive impairment, and for functional decline in IADL were female sex, fatigue, and risk for depression.

Discussion

Functional impairments are frequent in older persons with cancer and a frailty risk profile, and several characteristics are identified that are significantly associated with functional decline. Therefore, FS is an essential part of the geriatric assessment which should be standard of care for this patient population. Next step is to proceed with directed interventions with the aim to limit the risk of functional decline as much as possible.

中文翻译：

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老年癌症患者的功能状态和虚弱风险状况：一项多中心观察研究

介绍

功能状态 (FS) 和虚弱是老年人尤其是癌症患者的重要担忧。关于 FS（日常生活活动 [ADL]；日常生活工具活动 [IADL]）及其在老年患者癌症治疗过程中的演变和虚弱风险状况的数据很少。因此，本研究检查了 FS 及其在老年癌症患者和虚弱风险概况中的演变，并调查了与功能下降相关的特征。

材料与方法

该二次数据分析以 FS 为重点，使用了一项大型前瞻性多中心观察性队列研究的数据。纳入了 ≥ 70 岁的实体瘤患者和基于 G8 筛查工具（评分 ≤ 14）的虚弱风险状况。进行了一项老年评估，包括基于 ADL 和 IADL 的 FS 评估。在大约三个月的随访中，对 FS 进行了重新评估。使用单变量和多变量逻辑回归分析来确定 ADL 和 IADL 功能下降的预测因素。

结果

3388 名患者在基线和随访时获得了 ADL 和 IADL 数据。在基线时，1886 名 (55.7%) 患者依赖 ADL，而 2085 (61.5%) 名患者在随访时依赖。23.6% 的患者出现功能下降。对于 IADL，2218 名（65.5%）患者依赖 IADL，而 2591 名（76.5%）患者在随访时依赖。在 41.0% 的患者中观察到 IADL 的功能下降。在多变量分析中，III 期或 IV 期疾病、合并症、过去 12 个月的跌倒史和 IADL 测量的 FS 是 ADL 和 IADL 功能下降的预测因素。ADL 功能下降的其他预测因素是多药治疗、东部肿瘤合作组-表现状态 (ECOG-PS) 评分 2-4 和认知障碍，IADL 功能下降的其他预测因素是女性，

讨论

功能障碍在患有癌症和虚弱风险的老年人中很常见，并且确定了几个与功能下降显着相关的特征。因此，FS 是老年评估的重要组成部分，应该成为该患者群体的护理标准。下一步是进行定向干预，目的是尽可能限制功能下降的风险。